Exceptional Patient Experience

1. Exceptional Patient Experience • Leadership Development Session • August 27 & 28, 2013 • Beverly Begovich • April Fairey • Lara Burnside

2. Healthcare Today? • Positive Image or Negative Image? • Trusted or Feared?

3. Objectives for Today • Review the impact of patient satisfaction • Introduction to Words that Work that demonstrates patient focused care • Understand differences between traditional patient rounding and “focused” patient rounding • Next steps for creating Words that Work that demonstrates patient centered care and getting to the “wow” experience

4. Gallup Poll

5. Do we really know what our patients want?

6. Patient Expectations • Don’t harm me • Make me better • Be nice to me Health Pulse of America Center for Survey Research – State University of New York, Stonybrook Do you worry something might go wrong during your hospital stay? 55% somewhat worried or very worried of a wrong treatment or serious infection while in the hospital.

7. Words that Don’t Work • You picked the wrong hospital to come to… • They never know what to do when I come here. • I never heard of that. I don’t know what to do. • It’s change of shift; you have to wait. • Nothing happens from 6:45 to at least 7:30. • No family is allowed in our ED bays the fist half hours;you know that rule!

8. Situations to Use Words that Work • High Volume Cycles of Service • Greetings • Goodbyes • Transitions/Handoffs at change of shift • Service Recovery • Delays • Waiting Room Protocols

9. The Voice of Our Customer • Why does this matter?

10. I gave you “usually” on your survey. I am six times morelikely to go to your competitorin the future.

11. I gave you “Always” on your survey. I am six times lesslikely to go to your competitorin the future.

12. What’s in the gap between the “usually” and the “always”? • The “very goods” to the “excellents”

13. The gap is the difference between the expectation and the actual experience

14. The Patient Experience: 3 Components • Loyalty • Emotional bonding • Psychological commitment • Likelihood to Recommend • Satisfaction • Meet/exceed expectations • Outcome delivered • How “Well” • Perceptions • Formed by experience • Perceptual quality • Behavior and consistency • How “Often” Traditional Satisfaction Survey HCAHPS

15. Impact of Transparency • Web traffic has increased 500% since Hospital Compare began publically reporting HCAHPS

16. Leader Rounding at Four Levels

17. Focused • Traditional vs. • Patient Rounding • Defined population daily • All new or All DC • Clinical Assessment • IP visit • Complaint Visit • Part of Interdepartmental Rounding • Problem disposition • Problem patient • Population is staff driven • Focus is derived from action plans your staff has committed to • Goal is listen and confirm that actions are consistent in all staff • Goal is setting expectation “our goal is excellent care…” • Goal is fix problem and seek recognition for staff

18. Outcomes for Patient/Family Rounding • Build relationships • Reward and recognize • Ensue patient safety • Ensure high quality of services provided • Identify opportunities for improvement • Remove barriers to a “WOW” experience

19. Getting Started • What is the goal? Overall satisfaction Percentile vs. Mean Percent? • What is the action plan decided on by the staff to address the priority items in the survey? • What questions might be asked that will validate consistency in following the action plan? • How frequently will rounding occur for patient/family?

20. Preparing to Round • Patient satisfaction surveys, comments, reports, censuses, and knowledge of services provided • Staff assignments • Business cards • Dry erase markers and/or pad and pencil • Ancillary department numbers and resource information • Items for “On the Spot” reward and recognition

21. Rounding Steps

22. Step 1: Build the Relationship • Provide an introduction • Maintain eye contact/smile • Put the person at ease

23. Step 2: Set Expectations • Explain reason for rounding • Encourage open and honest communication

24. Step 3: Focus the Inquiry • Listen, learn, and share • Use specific language that will get to the goal of improvement • Focus on fact-finding, not fault-finding • Ask probing questions – high-gain, open-ended • Be persistent and consistent

25. Step 4: Close the Encounter • Offer to provide additional assistance/help • Tell them what you will do with the information and by when • Say “thank you” and leave your contact information

26. Step 5: Act on the Information • Take notes and follow-up on actions • Act on opportunities for improvement • Under promise and over deliver • Reward, recognize, and celebrate! • Trend issues/opportunities for improvement • Share finding with the senior leaders, peers, and employees

28. Using Patient Data to Create Action Plan • Review Patient Measurement Report and identify the department’s top three priorities • Appoint one person in each group to act as the leader, the remainder of group are now staff members • Leadersfacilitate discussion with group to: • Identify the actions you will take to address top three priorities identified from sample Measurement Report • IE safety is top priority, action could be “This ID band is the first step in keeping you safe in our hospital”

29. Action Plan continued • Educate all staff to actions and advise effective date • Display agreed actions in common area on unit for visibility • Leaders document agreed actions on Pt. Rounding Log • Select patient population for rounding (consider staff assignment) • Begin rounding with focused questions • Document outcomes on rounding log • Share findings with staff and senior leaders

30. Entry Script To Interact with Patient’s Family • “I’m _______, the Director of _________. Our goal is that you receive Very Good care while you are a patient here. • Do you have time to answer a few questions for me?

31. Discovery and Apology Scripts • In the last 24 hours have you needed to use your call light? If so, what for? Were we timely in our response? • Describe your experience. • Tell me more. • Is there anyone I can recognize for providing you with “excellent” care? What exactly did they do? • I apologize for the delay in answering your call light. Tell me how I can make this better for you?

32. Conduct Rounding and Document

34. Focus on the Positives • Manage up • Send “Thank You” notes to the employee’s home • During rounds, identify employees within your department, as well as employees from other departments, who should be recognized for consistently following the action plan • Recognize those employees mentioned by name • Involve employees in the decision making process

35. Does Focused Patient Rounding • Really make a difference?

36. Outcomes of Leaders Rounding on Patients • Patients rounded on by Nurse Leaders reported satisfaction levels on average 59 percentile points higher than patients not rounded on by nurse leaders • Decrease patient complaints by 66% • Reduce Emergency Department LWOT from 4.5% to 2%

37. 90 82 81 76 80 71 66 70 60 50 40 30 30 21 20 13 11 6 10 0 Aug Apr May Jun Jul Aug Apr May Jun Jul All Hospitals Inpatient - 2009 • Percentile Ranking Nurse Leader Rounded Yes No

38. Journey from the 24th to 99th percentile in 24 months Implemented Monthly Patient Satisfaction Tracking and Reporting System: turning data into actionable knowledge and transparency, accountability, Rounding, Words that Work

39. Impact of Rounding

40. Likely Barriers to Effective Focused Rounding: • Not prioritized as part of daily schedule • Distractions and called to fight “fires” • Accountability Gaps • Overall lack of belief in patient focused rounding as a critical management tool • Failure to act on the information

41. Questions?

42. Thank You.